This article was published in partnership with the Houston Chronicle.

Parents in Michigan lost custody of their 6-week-old son after a doctor observed marks on the baby’s abdomen and reported them as “diagnostic of physical abuse.” A judge ordered the child and a sibling to be returned months later, however, after hearing evidence that the lesions were likely caused by the straps of a baby swing.

A special education teacher in Florida and her paramedic husband were separated from their 4-month-old son after a doctor told child welfare workers that bleeding in the boy’s brain must have been the result of violent shaking. But the doctor had overlooked an underlying medical cause.

And in Washington state, two children were taken from their mother after a doctor reported that she had been abusing them with unnecessary medical treatments. The children were returned 14 months later, when a judge ruled that most of the physician’s testimony was “without supporting factual basis.”

These stories are among those shared with NBC News and the Houston Chronicle by more than 300 families from 38 states, following a yearlong investigation highlighting the plight of parents accused of child abuse based on mistaken or overstated reports by doctors. The flood of responses demonstrates the nationwide reach of problems detailed in the series, which showed that child welfare workers in Texas removed children from homes after receiving reports from doctors that were later called into question.

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The NBC News and Chronicle reporting focused on the work of child abuse pediatricians, a small but growing subspecialty of physicians who work closely with state child welfare agencies. They provide expert reports and court testimony in thousands of cases a year, shielding untold numbers of abused children from additional harm. But when the evidence is less clear, the investigation found, a mistaken or overstated diagnosis of child abuse can devastate families.

The families who contacted reporters in recent weeks described their horror at being accused of abuse and the agony of weeks or months apart from their children. Many of the parents remain without their children and wrote pleading for help finding lawyers or medical experts to review their cases. Others had successfully fought to regain custody, but only after taking out tens or hundreds of thousands of dollars in loans for legal fees that they are now struggling to repay.

Allie Parker of Michigan, a mother of two young children, said the NBC News and Chronicle series has been “opening a lot of people’s eyes.”

Parker is pushing for legislative and policy reforms in Michigan after she and her husband lost custody of their children last year based primarily on the opinion of a child abuse pediatrician at C.S. Mott Children’s Hospital in Ann Arbor. The doctor said red splotches on their 6-week-old’s skin and healing rib fractures were each “diagnostic of physical abuse.”

Other experts who reviewed the records and examined the baby on behalf of the Parkers disagreed. Two of the doctors noted that the baby had a significant Vitamin D deficiency that could lead to fractures in infants from routine handling. Another reported that the marks on the child’s skin — which the parents first noticed and brought to the attention of doctors — did not behave like bruises, and appeared to match the straps of the baby’s swing.

After more than seven months and $50,000 in attorneys’ fees, a judge apologized to the Parkers and ordered that their children be returned.

In response to questions, C.S. Mott spokeswoman Mary Masson said in a statement that the hospital’s child abuse pediatricians “have the knowledge and expertise to meticulously assess complex medical information and develop an extensive list of possible diagnoses other than child abuse or neglect. The child protection team is invaluable to the health system in ensuring the safety and well-being of children.”

Opinions offered by child abuse pediatricians are not legal decisions, Masson added. Likewise, she said, “determinations made by the court system do not indicate that a diagnosis made by a child abuse pediatrician is incorrect.”

A year after being reunited, Parker said she and her husband are still grappling with the trauma of having their children taken from them. But she’s also using her experience to assist other families facing similar allegations.

“This is not isolated to Texas,” Parker said after reading the investigation. “It’s an epidemic across our nation.”

Learning from mistakes

Hospitals have long employed doctors with a special interest in child abuse, but it wasn’t until a decade ago that the American Board of Pediatrics certified a new medical subspecialty dedicated to protecting children. Today, about 375 child abuse pediatricians practice throughout the U.S.

By law, all doctors are required to notify authorities when they suspect a child may have been abused. Child abuse pediatricians go further: They then examine a complete picture of the child’s injuries and try to confirm whether abuse has occurred, diagnosing not only a child’s medical condition, but also what caused it.

The work is vital in a nation where 1,700 children die of abuse or neglect each year. But reporters found instances where child abuse doctors overstated the reliability of their findings, using terms such as “100 percent” or “certainly inflicted” to describe conclusions that usually cannot be proven with absolute confidence. There is no lab test to confirm that a baby has been shaken or to prove that a child’s scalding burns were inflicted.

The doctors’ opinions can have an extraordinary influence over the decisions of state child welfare agencies, sometimes triggering questionable family separations and criminal charges, the series found.

In response to the reporting, Dr. Kyle Yasuda, president of the American Academy of Pediatrics, and Dr. Tammy Camp, president of the Texas Pediatric Society, wrote an op-ed article in the Chronicle defending the work of child abuse pediatricians and highlighting the potentially deadly consequences of missing signs of abuse. Child abuse pediatricians, they wrote, actually rule out abuse more often than other medical specialists such as emergency room doctors, protecting families from needless separations.

“Most other physicians simply don’t have as much training in distinguishing accidental injuries from intentional injuries, or in spotting the rare conditions that often look like abuse,” Yasuda and Camp wrote.

Dr. Richard Krugman, a professor of pediatrics at the University of Colorado School of Medicine and a leading figure in the field of child abuse prevention, said some of the criticism of child abuse pediatricians from defense lawyers and dissenting medical experts has been “over the top.”

But when it’s estimated that a misdiagnosis contributes to 1 out of every 10 patient deaths in the U.S., Krugman said it’s not surprising that child abuse pediatricians are not right every time. A major problem, he said, is that doctors can only learn from mistakes if they are made aware of them. After an abuse diagnosis is made and a child is separated from a family, he said it’s difficult to know whether that was the right call.

That’s in part, Krugman said, because most state child welfare agencies do not track long-term outcomes or share the data with researchers.

“Whatever mistakes are made in this field,” he said, “child abuse pediatricians and others are put in a position where they can’t learn from them because they don’t know the outcomes.”

Often, it’s only when parents have the financial resources to hire seasoned lawyers or additional medical experts that doctors might learn of information that contradicts their findings.

No factual basis

Megan Carter was separated from her two children for more than 14 months after a child abuse specialist at Mary Bridge Children’s Hospital in Tacoma, Washington, accused her of committing a rare form of child maltreatment known as medical child abuse. The doctor, Elizabeth Woods, reported to child welfare officials in May 2018 that Carter had been abusing her 5-year-old daughter, Ellie, by exaggerating her health problems in order to fool doctors into giving her unnecessary and harmful medical treatments.

But after a lengthy trial more than a year later, a judge dismissed the case and took Woods to task in her written order for failing to present a factual basis for her findings.

The case followed a familiar pattern from other medical child abuse cases examined as part of the NBC News and Chronicle investigation: Ellie was born severely premature, at 24 weeks, and as a result suffered from developmental delays and chronic health problems, including breathing and digestive difficulties. After years of treatment for these issues, a hospital employee came to suspect that the child wasn’t as sick as her mother portrayed her to be. The case was referred to Woods, who examined the child’s extensive medical records in the spring of 2018 and concluded that Carter had been abusing the girl with excessive treatments.

The doctor reported that the abuse likely had gone on from the time the child was born, and even pointed to a touching moment, when a famed NFL player came to visit Ellie in the hospital, as evidence that Carter was using her child’s illness to gain attention for herself, according to court records.

But the doctor repeatedly overstated or misstated the evidence for her conclusions, the judge found. Woods’ claims that Carter tampered with her daughter’s medicine, that she pushed for needless oxygen treatments and that she made up her child’s feeding difficulties were not supported by medical records or testimony from physicians who cared for the girl, the judge ruled.

The doctor’s claim that the child “wolfed down” a McDonald’s Happy Meal after Carter was removed from her care was disputed by other witnesses and simply was “not plausible,” the judge wrote, because the child has continued to have legitimate eating struggles. And it was hospital staff members, not Carter, who invited former Seahawks cornerback Richard Sherman to surprise Ellie in the hospital, the judge wrote, noting that Mary Bridge officials widely promoted video of the moment in marketing materials and social media postings, including in posts seeking donations for the hospital.

If there was anything to gain from the visit, the judge wrote, “the benefit was gained by the hospital and not the mother.”

Marce Edwards, a Mary Bridge spokeswoman, said in a statement that the hospital “takes seriously its role to keep the kids of our community safe and that means alerting authorities when we have a reason to question a child’s safety.”

“The Mary Bridge Child Abuse Intervention Department has been serving our community for more than 30 years and is a critical resource in the prevention and treatment of child abuse,” Edwards said. “We stand by the work they do and by Dr. Woods.”

Woods did not respond to a message left on her cellphone.

Carter was reunited with both of her children in June, but only after she and her husband took out loans and borrowed from family members to cover their $300,000 in legal fees. Her children see a therapist to help them with their lingering fears of separation, Carter said.

After reading the NBC News and Chronicle investigation into a strikingly similar case against a mother in Houston, Carter contacted reporters and asked to share her story.

“After we went through this, I wanted to just crawl away and never talk about it again,” Carter said. “But then I was like, this is just going to keep happening. These people are out of control.”

‘They made us feel like we were monsters’

Vivianna Graham, a special education teacher in Florida, underwent four years of fertility treatments with her husband before finally giving birth to their son, Tristan, in 2015.

On the day Tristan turned 4 months old, he suffered a seizure, and doctors at Johns Hopkins All Children’s Hospital in St. Petersburg found bleeding around his brain. Although Tristan had no other injuries, according to medical records, a child abuse pediatrician, Dr. Sally Smith, reported that the subdural bleeding was likely the result of violent shaking, or abusive head trauma.

Within days, the state took custody of the baby and police charged Graham’s husband, Jeremy Graham, a firefighter paramedic, with felony child abuse. His mugshot and news of the charges flashed across TV screens throughout the region that evening during local news broadcasts.

“They made us feel like we were monsters,” Vivianna Graham said.

But three other doctors who reviewed the medical records at the request of the Grahams, including a neurosurgeon, found no evidence of abuse. They wrote in their reports that Tristan’s brain bleeding — which continued even after he was taken from his parents — was the result of a chronic condition in which fluid builds up in an infant’s head, in some instances triggering small amounts of bleeding between the brain and skull.

A spokeswoman for All Children’s Hospital declined to answer questions or comment on the case, citing patient privacy rules. In a short phone conversation, Smith said she was not permitted to comment.

“These cases are confidential,” Smith said. “I’m not at liberty to tell you my side of the story.”

Seven months after Tristan was removed, the criminal charges against his father were dropped and the baby was returned.

Every year since, the Grahams have sent Smith, the child abuse pediatrician, a Christmas card with a photo of their family, along with a note reminding her that she almost broke them apart.

Last December, they were shocked when Smith responded with a note of her own. The doctor pointed out that there is a “disturbing number” of children in the Tampa area who are victims of abuse each year, but she acknowledged the Grahams’ strong belief that their son wasn’t one of them.

“I try very hard to be thorough and ‘get it right,’ but perhaps,” Smith wrote, “I need to be more careful to consider gray areas.”